What we can do now about our opioid national health emergency?

November 16, 2017

The federal government in late October declared the opioid crisis a national public health emergency. The President’s Commission on Combating Drug Addiction and the Opioid Crisis headed by Gov. Chris Christie issued its final report.

Where does this leave us?

Consider the facts.

The Centers for Disease Prevention and Control (CDC) reported 64,000 drug overdose deaths in 2016, more than the 58,000 lives lost in the Vietnam War. Deaths from prescription opioids more than quadrupled since 1999. Deaths from heroin overdose grew from 2,089 in 2002 to 15,446 in 2016. The amount of prescription opioids sold to pharmacies, hospitals and doctors’ offices nearly quadrupled from 1999 to 2010.

According to the Minnesota Department of Health, Minnesota opioid overdose deaths increased by 430 percent since 2000, climbing to 376 in 2016. Fewer than 10 Minnesotans died from heroin overdose in 2008, compared with 142 in 2016.

Consider the solutions.

The historical response to a drug epidemic in the United States is three-pronged: law enforcement to curtail the supply, prevention to deter new users and science-based treatment services for those already addicted.

When it comes to opioids, the steady influx of deadly synthetic drugs, such as fentanyl, that are found in counterfeit pills and the street drugs complicate the role of law enforcement. The voices of drug-abuse prevention are seemingly drowned out by the 60 percent of Americans who favor legalization of marijuana, and nine states with legalized recreational use. As for treatment, although scientific evidence clearly supports the use of medication-assisted therapy in the treatment of opioid use disorders, it is significantly underutilized.

With the opioid crisis we must also examine the practice of medicine.

It is not simply a matter of reducing the number and duration of opioid prescriptions, although that is a significant part of the solution. We need routine screening for substance-use disorders integrated into primary care, additional medical education regarding pain management and addiction, application of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, enhanced use of Prescription Monitoring Programs, and expanded, more timely access to science-based addiction treatment services, to name a few.

What has been done so far?

Law enforcement keeps seizing record amounts of heroin and methamphetamines. There are ways to dispose of unused prescriptions. Most states have Naloxone laws to revive the overdosed and Good Samaritan laws to protect those who call for help. Drug courts have demonstrated their effectiveness for decades. Advocacy and prevention groups have formed. Most states have prescription monitoring programs. Last week in Minnesota the governor announced the infusion of $16.6 million in state funds to expand the geographic reach of medication-assisted treatment and other services.

What’s next?

That it is now called a “public health emergency” may indeed foster broader public dialogue about the opioid crisis. But it comes with no new funding. This lack of accompanying fiscal support reminds us that we cannot rely solely on the federal government to pull us out of this predicament. Just as heightened public awareness and conversation alone are inadequate solutions, so are recommendations without the monetary resources needed for real-world implementation.